Provider Demographics
NPI:1154357697
Name:STRUBY, BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:STRUBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8489 FAIRWAY CHASE TRL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-4869
Mailing Address - Country:US
Mailing Address - Phone:775-747-0476
Mailing Address - Fax:
Practice Address - Street 1:9598 PROTOTYPE CT STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-3950
Practice Address - Country:US
Practice Address - Phone:775-852-8181
Practice Address - Fax:775-852-8199
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5514-0151223G0001X
NV4854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice